MEDICARE: KATHERINE BAILEY DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	016003426	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	480034798	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0060101255	OTHER		BCBS

General Provider Information

NPI Number	:	1972698645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE BAILEY DPM

Provider Business Mailing Address
First Line	:	1307 W WASHINGTON
Second Line	:	STE 100
City	:	OREGON
State	:	IL
Zip	:	61061-1022
Country	:	US
Telephone Number	:	815-732-2581
Fax Number	:	815-732-3926

Provider Business Practice Location Address
First Line	:	1307 W WASHINGTON
Second Line	:	STE 100
City	:	OREGON
State	:	IL
Zip	:	61061-1022
Country	:	US
Telephone Number	:	815-732-2581
Fax Number	:	815-732-3926

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	05/06/2008

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Directions to “ KATHERINE BAILEY DPM” Practice Location

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